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目的：探讨行重组人p53腺病毒（rAd-p53）瘤内注射联合放化疗前后的鼻咽癌原发灶组织病理学变化及其预后关系。方法89例确诊中晚期鼻咽癌的患者随机分为2组。治疗组（49例）：rAd-p53瘤内注射+同步放化疗。对照组（40例）：同步放化疗组。于治疗前及放疗至20Gy（第三次rAd-p53治疗后）时取鼻咽部瘤体活组织标本。采用常规HE染色法检测鼻咽癌原发灶组织病理学形态特征。结果放疗至20Gy时所取病理标本显示治疗组鼻咽癌原发灶组织肿瘤细胞放射损伤严重，与对照组有显著性差异(P＜0.05)，其中治疗组20例（20/48例）鼻咽癌原发灶组织未发现肿瘤细胞；对照组8例（8/38例）鼻咽癌原发灶组织未发现肿瘤细胞，有显著性差异（p=0.043）。治疗组和对照组患者5年总生存率分别为70.71%和73.07%，无显著性差异（p=0.744），但于放疗至20G y取的病理样本显示鼻咽癌原发灶组织肿瘤细胞阴性的患者其5年的总生存率（77.62%）优于阳性组（69.06%），差异接近有统计学意义（p=0.054）。结论 rAd-p53瘤内注射后与放疗具有协同作用，可加重肿瘤细胞的放射损伤反应，有助于提高患者的预后，延长患者生存期。“,”Objective To compare the histopathological changes after adenovirus p53(rAd-p53)intratumoral injection combined with radiotherapy and chemotherapy on treatment of advanced stage nasopharyngeal carcinoma.Methods 89 cases with advanced stage nasopharyngeal carcinoma were randomly divided into two groups. The therapy group: intratumoral injection rAd-p53 plus radiotherapy and chemotherapy group, the control group: radiotherapy and chemotherapy group. The histopathological changes were compared between the two groups. Histopathological changes including necrosis of tumor and changes of matrix and vessels.Result Significant difference was found radioactive damage of tumor between therapy group and control group (P<0.05). Tumor cels of 20 cases (20/48 cases) in therapy group disappearring was significantly more than control group (8/38 cases). The 5-year survival rates of The therapy and control groups were 70.71% and 73.07%( p=0.744).The survival was significant improved in negative tumor cels than positive tumor cels group(p=0.054).Conclusion While a cooperative action was observed in rAd-p53 and radiotherapy,rAd-p53 could enhance the radioactive damage of tumor effect,improving prognosis,prolonging survival in the advanced stage NPC.